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目的探讨MR扩散加权成像(DWI)在肝癌经导管动脉化疗栓塞术(TACE)后随访中定性和定量评价残留或复发肿瘤组织的能力。方法对16例行TACE术后肝癌患者分别进行DWI、上腹部增强CT和DSA造影检查。DWI检查取扩散敏感梯度因子(b值为0及500s/mm~2),利用固定参数组合的自旋回波-平面回波(SE-EPI)序列。与上腹部增强CT和DSA造影检查相对照,观察碘化油沉积灶、肿瘤坏死组织和肿瘤组织在DWI上的信号特征;分别测量TACE术后病灶的ADC值和对应的CF最大强化值,并作相关性分析。结果DWI显示TACE术后病灶内部信号较复杂,2例(2/16)病灶碘油沉积完整,DSA检查无肿瘤染色,CT图像显示为完整的碘化油沉积灶,DWI为均匀低信号;2例(2/16)病灶为碘油沉积但出现局部缺损,DSA检查可见缺损区肿瘤染色,DWI图像上碘油沉积区表现为低信号,肿瘤染色区为高信号;12例(12/16)病灶DSA检查可见无或稍许碘油沉积,造影见大量肿瘤染色,其内可见无或轻微染色的缺血、坏死肿瘤组织,DWI图像上肿瘤染色区域表现为高信号,缺血坏死区为低或较低信号;对14例(14/ 16)病灶内肿瘤组织的ADC值与其最大CF强化值进行相关性分析,两者存在相关性(r=-0.76490,P<0.01)。结论DWI是一种灵敏的检测肝癌TACE术后肝内新发病灶的无创性成像方法,可监测TACE术后病灶残留或复发活组织和坏死情况,小b值(500s/mm~2)的ADC值可在一定程度上反映肿瘤的血供,可以用于肝癌TACE术后随访。
Objective To investigate the ability of MR diffusion weighted imaging (DWI) in the qualitative and quantitative evaluation of residual or recurrent tumor after follow-up of transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma. Methods Twenty-six patients with hepatocellular carcinoma after TACE were examined with DWI, contrast-enhanced CT and DSA. Diffusion-sensitive gradient factors (b-values of 0 and 500 s / mm ~ 2 were taken for DWI), and spin echo-plane echo (SE-EPI) sequences were combined using fixed parameters. Compared with contrast-enhanced CT and DSA in upper abdomen, the signal characteristics of iodized oil deposits, tumor necrosis tissues and tumor tissues on DWI were observed. The ADC value of lesions after TACE and corresponding maximum CF value were measured. Make correlation analysis. Results DWI showed that the internal signals of lesions were complicated after TACE. Lipiodol deposition was complete in 2 cases (2/16), no tumor was stained by DSA, CT images showed complete iodinated oil deposition and DWI was uniform low signal.2 In the case of (2/16), the lesions were lipiodol deposition but local defect. DSA showed that the tumor in the defect area was stained. In the DWI image, the lipiodol deposition area showed low signal and the tumor stained area was high signal. In 12 cases (12/16) DSA examination of the lesion showed no or little lipiodol deposition, a large number of tumor imaging showed staining, which can be seen without or slight staining of ischemic and necrotic tumor tissue, DWI images of tumor staining area showed high signal, ischemic necrosis area is low or (R = -0.76490, P <0.01). Correlation analysis showed that there was a significant correlation between ADC value and maximum CF value in 14 (14/16) lesions. Conclusions DWI is a sensitive noninvasive imaging method for the detection of new intrahepatic lesions after TACE in hepatocellular carcinoma. DWI can monitor the residual or recurrent tissue and necrosis of lesions after TACE, and the small b value (500s / mm ~ 2) The value can reflect the blood supply of the tumor to a certain extent and can be used for follow-up of TACE of liver cancer.